HTN

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  • Hypertensive emergency
  • DDX
  • Order 1:
  • Physical examination
  • General,
  • HEENT/Neck,
  • Heart, Lungs,
  • Abdominal,
  • Extremities,
  • Neuropsychiatric
  • Result
  • Order 2:
  • IV access, stat
  • Oxygen inhalation, continuous
  • Pulse oximetry, stat and continuous
  • Cardiac monitor, continuous
  • Continuous BP cuff
  • 12 Lead EKG, stat
  • STAT Order 3:
  • CT scan of head, stat ( without contrast to look for edema, hemorrhage, infraction)
  • Results:
  • Order 4
  • Nitroprusside, IV, continuous (monitor the patient for hypotension)

  • After starting treatment, order basic labs to assess the end organ involvement.
  • CBC with differential, stat (for microangiopathic hemolytic anemia)
  • BMP, stat (for possible renal involvement)
  • Urinalysis, stat (for possible renal involvement)
  • CXR-PA view, stat (to look for the evidence of pulmonary edema)
  • *Shift the patient to ICU
  • Order 5:
    NPO
    Bed rest, complete
    Urine output
  • Result:
  • Order 6:
  • *Shift the patient to the ward/floor
  • D/C cardiac monitor, oxygen, pulse oxy, NPO, bed rest
  • Vitals Q 6 hours
  • Metoprolol or hydrochlorothiazide, oral, continuous
  • Low salt diet
  • Once the blood pressure is controlled with oral antihypertensive agents, the patient can be sent home with the following orders  
  • Order 7:
    Lipid profile, routine
  • Patient counseling
  • Regular exercise
  • Medication compliance
  • Smoking cessation
  • Alcohol, advice patient to limit intake
  • Seat belt use
  • No illegal drugs  

Dr. Soryal, George